Ken Hall Reports: In medical care, the big gap is in dentistry

Sunday

Jan 20, 2013 at 2:00 AM

Show up at the emergency room with an abscessed tooth and you'll get medication for the infection and the pain. Unless you get treatment for the underlying cause, however, you will be back, part of an expensive and painful cycle that has not received the kind of attention that has focused on other health care needs.

Ken Hall

Show up at the emergency room with an abscessed tooth and you'll get medication for the infection and the pain. Unless you get treatment for the underlying cause, however, you will be back, part of an expensive and painful cycle that has not received the kind of attention that has focused on other health care needs.

There certainly are enough scary statistics. An estimated 17 million children in the nation do not get regular dental care. In 2009 hospital emergency rooms reported 830,000 visits, 49,000 of them by children, for treatment of preventable dental problems.

The Pew Center on the States has compiled those numbers along with some examples of how hard it can be to get affordable dental care and how some states are trying to change that by expanding the way these services are delivered.

Minnesota has filled in the dental care gaps by licensing dental therapists who can put in crowns, fill cavities and extract teeth. California, Kansas, Maine and New Hampshire are considering similar training and licensing programs. Alaska started using dental therapists a decade ago and had to send them to New Zealand for training because none was available in the United States.

New York is not yet paying attention even though the same forces are very evident. Even before the state cut fees by double digits a few years ago, only 20 percent of the dentists in the state would take Medicaid patients. Some of those reduced fees were for cleanings, fillings, sealants and X-rays, the procedures that are most effective in diagnosing problems so they can get fixed before they become yet another emergency.

Although this is a problem for people of all ages the young are most at risk. Anecdotal evidence is mounting about children with decay problems so extensive that they require surgery under anesthesia. Even those with less severe problems are likely to condemn themselves to a lifetime of pain and complications if they don't get help soon.

In the last legislative session there was only one bill dealing with this issue, a modest one to expand the availability of dental hygienists. It would have allowed them to work outside of a dental office as long as they did so under what was called a "collaborative practice agreement." The bill went nowhere.

If anybody tries to bring up the idea of dental therapists, I imagine it will get the same chilly reception here as it has received elsewhere. Most state dental associations insist that only licensed dentists can do this work. Yet physicians have overcome similar outdated ideas and embraced practices that improve efficiency and help deliver better care. Patients are routinely treated, with great success I can add from personal experience, by nurse practitioners and physician assistants. They have taken over many tasks once performed only by doctors, just as dental therapists in Minnesota have done for all of the same good reasons.

If these therapists are not the answer, someone needs to come up with another one.